Provider Demographics
NPI:1831159664
Name:MARCUS GARVEY RESIDENTIAL REHAB PAVILION
Entity type:Organization
Organization Name:MARCUS GARVEY RESIDENTIAL REHAB PAVILION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-467-7300
Mailing Address - Street 1:810 SAINT MARKS AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-1420
Mailing Address - Country:US
Mailing Address - Phone:718-467-7300
Mailing Address - Fax:718-467-7878
Practice Address - Street 1:810 SAINT MARKS AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-1420
Practice Address - Country:US
Practice Address - Phone:718-467-7300
Practice Address - Fax:718-467-7878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00314627Medicaid
335609Medicare ID - Type Unspecified